This proposal requests support for a comprehensive examination of the multiple functional outcomes and special health care needs of <1000 gm birth weight children at school age. A cohort of 221 <1000 gm children born 1992-1995 was evaluated at 20 months corrected age at which time 48% had neurologic and/or developmental impairment. In the proposed study, we plan to examine their school age functioning and special health care needs at age 8 years compared to normal birth weight school controls matched by age, gender and race. To assess Health Status and Special Health Care Needs, we plan to use recently developed measures of child health (the Child Health and Illness Profile (CHIP-CE) and the Questionnaire for Identifying Children with Chronic Diseases (QuICCC), together with the more traditional categorical measures of neurosensory and developmental outcome. Data collection will include parent, child and teacher questionnaires and interviews, direct assessment of physical and neurosensory status and psychometric testing We hypothesize that the outcomes of the < 1000 gm birth weight children will differ in three ways from outcomes of the normal birth weight controls at age 8 years; a) From the parent and child's perspective, children of <1000 gm birth weight will have poorer general health status and more functional limitations, need for compensatory aids and services above routine; b) Using direct assessment methods and teacher report, < 1000 gm birth weight children will have higher rates of subnormal growth, neurosensory impairments and poorer cognitive ability, academic achievement, neuropsychologic functioning and school performance; and c) Parents of < 1000 gm birth weight children will report a negative impact on the family including higher rates of family dysfunction, maternal depression and economic hardship. Data analysis will include examination of group differences; the relationship of direct assessments of the child to parent and child-based reports of health outcomes; and the relationship of social and biologic factors to the child's functioning and to impact on the family. This study will provide critical research-based and policy related information needed both for measuring outcomes of neonatal intensive care and for the planning and provision of services for high risk children.